Volume 106, Issue 5 (August 2007)

Editorials

You may recently have seen that Governor Doyle’s 2007-2009 budget proposal would require group health insurance plans to cover treatment for autism. Now that autism is a household word, and affects upward of 1/150 children in Wisconsin, everyone has been touched by someone who has this diagnosis. But I think the attention to autism, to the exclusion of other disabilities, misses an important point—that autism is but one aspect of complex neurodevelopmental disorders.

John J. Frey, III, MDWhy can’t a man be more like a woman?
(full text PDF)

When I graduated from medical school in 1970, I had 9 women classmates out of 145. However, for over a decade, women have been the majority of medical students in the United States, joining many other countries where women have been the majority of doctors. Two-thirds of all medical students in the United Kingdom are women.

Commentaries

The Wisconsin Medical Society launched its redesigned Web site last month, featuring an updated look, an improved search function, easier usability, and additional improvements and features. But perhaps the most exciting aspect of the new site is that it serves as an entry point to DRconnection, the Society’s new physician information repository.

Original Research

Objective: This study explored the unique challenges and strategies of women in academic family medicine who are in dual physician families.

Methods: An e-mail survey was sent to all female physician members of the Society of Teachers of Family Medicine (STFM) who were listed in the on-line database. The survey collected demographic information, details of job descriptions and family life, and included 3 open-ended questions about the experiences of dual physician families.

Results: Over 1200 surveys were sent to women physicians in academic family medicine. One hundred fifty-nine surveys were returned. Half of all women worked full time compared to 87% of their partners. Most women reported benefits of having a physician partner including support and having an understanding person at home, though scheduling conflicts and childcare responsibilities contributed to the need for job compromises. Women prioritized finding work-life balance and having supportive partners and mentors as most important to their success as academic family physicians.

Conclusion: Dual physician relationships involve rewards and conflicts. More research should explore the competing demands of family life with success in academic medicine.

Background: While approximately 30% of the Wisconsin population lives in rural areas, only 11% of physicians practice in these areas. More women are entering medicine today and some studies have raised concerns that women are less likely to practice in rural areas. The intent of this study was to identify which factors influenced female physicians to enter rural practice and to look at the issues they are confronting.

Methods: Ten female physicians practicing in rural Wisconsin towns agreed to participate in 30- to 60-minute semi-structured interviews. Transcripts of the interviews were analyzed to identify common themes in answers to the questions.

Results: The physicians had been in practice between 2-26 years, with an average of 13 years. Seven of the 10 had rural backgrounds, which influenced their decisions to practice in rural areas. The physicians cited other factors, such as professional satisfaction, the ability to be engaged with and serve one’s community, and having a good place to raise one’s family, that made practicing and living in a rural community attractive. However, these physicians also found some drawbacks to rural practice, including too few providers, too much call, and finding a balance between professional and family life. Despite this, all plan to stay in their current practices indefinitely and recommend rural practice to female medical students and residents.

Conclusions: These female physicians find the value of being in rural practice overcome the challenges. The participants provided insight into motivating women to enter rural practice, finding a balance between the challenges and benefits of rural medicine, and promoting the future of rural health care.

Review Articles

The number of women in medicine has increased dramatically in the last few decades, and women now represent half of all incoming medical students. Yet residency training still resembles the historical model when there were few women in medicine. This article reviews the issues facing women in residency today. Data suggest that the experience of female residents is more negative than that of males. Unique challenges facing female residents include the existence of gender bias and sexual harassment, a scarcity of female mentors in leadership positions, and work/family conflicts. Further research is needed to understand the experience of female residents and to identify barriers that hinder their optimal professional and personal development. Structural and cultural changes to residency programs are needed to better accommodate the needs of female trainees.

Case Reports

We present a case of non-cirrhotic extrahepatic portal hypertension in a 31-year-old woman following extensive abdominal laparotomy for the drainage of multiple retroperitoneal and liver abscesses following a perforated appendix. Chronic portal, splenic, and mesenteric vein thrombosis with portal hypertension was caused by a hypercoagulable state due to the abdominal infection and abdominal surgery. Various etiological aspects of chronic extraheptic venous thrombosis have not been documented due to the low incidence of these events. We discuss these aspects in the context of our patient.

Injection of viscous or semisolid materials into the penile shaft to increase its size, to correct erectile dysfunction, and/or to satisfy a sexual partner has only been sporadically reported in Eastern and Western European and American men. However, this practice appears to be more widespread in the countries of Southeast Asia. We present 3 cases of Hmong patients seen in a urology clinic in Wausau, Wis. We describe the presentation, correction, and difficulties experienced in convincing patients to undergo adequate treatment.

Basal cell carcinoma of the sole is very rare. This report describes an occurrence in which a basal cell carcinoma may have developed in relation to radiation exposure from a shoe-fitting fluoroscope. The obvious limitation is that there is no record or means to measure any amount of radiation that a person may have received from this primitive fluoroscope. We conclude that radiation very likely did induce this lesion in this individual.

Your Practice

CMS Proposes Important Changes to the Stark Regulations
On July 2, 2007, while we were all busy looking for the Stark II Phase III regulations, which were due out a few months ago but have now been postponed indefinitely, the Centers for Medicare and Medicaid Services (CMS) released proposed revisions to the Medicare Physician Fee Schedule for 2008. Tucked within those 924 pages are 50 pages proposing major changes to the regulations under the Stark self-referral law.

Collecting and organizing your personal financial information is the first step in retirement planning. The following is a list of the documents you may or may not receive throughout your working years. Create a file for each of the following categories and you will not only tame the paper tiger, but you will have the information you need to build a successful retirement plan.

Your Profession

The Medical College of Wisconsin’s first class composed of 50% women just finished their M1 year. Our experience is a microcosm of the nation as a whole, with the Association of American Medical Colleges (AAMC) reporting that 48% of first-year students in the United States were women in 2005-2006, the most recent year statistics were tabulated.